距下关节镜-论文.pdf

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1、·80·外杂志电子版)2014年8月第8卷第4期ChinJJointSurg(ElectronicEdition)，August2014，Vo1．8，No．4综述·距下关节镜吕敦庆陈慧聪【摘要】距下关节是复杂的后足结构，可作内翻及外翻运动，具有重要的生物力学作用。距下关节由两个独立的关节腔共同组成，包括距跟舟关节(前距下关节)及距跟关节(后距下关节)，两个关节腔被跗骨窦及跗骨管所分隔。后距下关节镜的经典入路包括外侧人路或后侧入路，然而，这两种经典入路下仍无法完全暴露后距下关节的内侧部分及跗骨管。为此，后距

2、下关节镜的内侧人路及跗骨管人路应运而生，补充了经典入路的不足，使关节镜下完全暴露后距下关节成为可能。同样，前距下关节镜配合内侧距下关节和距舟关节镜可完全暴露前距下关节。随着手术器械及操作技术的进步，距下关节的不同部位的病变均能镜下观察及操作。SubtalararthroscopyLuiTunhing，ChanWaichung(Dr)2．1MBBS(HK)，FRCSEd，FHKCOS，FHKAM(OrthopaedicSurgery)，Consultant，DepartmentofOrthopaedicsa

3、ndTraumatology，NorthDistrictHospital，l-longKong，Email：luithderek@yahoo．co．uk．2FRCSEd(Orth)，FHKCOS，FHKAM(OrthopaedicSurgery)，ResidentSpecialist，DepartmentofOrthopedicsandTraumatology，PamelaYoudeNethersoleEasternHospital，MRCSEd，MBBS(HK)，Email：drwcchan@gmail

4、．con【Abstract】Subtalarjointisacomplexbutbiomechanicallyimportantjointinrearfootincontrollinginversionandeversionofthefoot．Ithastwoarticulations，talocalcaneonavicularjoint(anteriorsubtalarjoint)andtalocalcanealjoint(posteriorsubtalarjoint)．Theyareseparated

5、bythesinustarsiandthetarsalcana1．Thereisnoconnectionbetweenthetwoarticulationsnormally．Posteriorsubtalararthroscopyisclassicallyperformedbylateralorposteriorapproach．Howeverthemedialpartoftheposteriorsubtalarjointandthetarsalcanalcannotbereachedbytheclass

6、icapproach．Thedevelopmentofmedialsubtalararthroscopyandthetarsalcanalarthroscopycomplementthestandardlateralandposteriorapproachesandmakecompleteaccessoftheposteriorsubtalarjointpossible．Similarly，completeaccesstotheanteriorsubtalarjointispossiblewiththea

7、nteriorsubtalararthroseopy，medialsubtalararthroscopyandtalonariculararthroscopy．Withtheadventinsurgicaltechniquesandinstrumentations，variouspartsofsubtalarjointcannOWbereachedarthroscopieallyanddifferentsubtalarpathologiescanbedeahwitharthroscopieally．cal

8、canealfacetsarticulatingwiththetalus．TheposteriorsubtalarIntroductionjoint，ortalocaleanealjointincludestheposteriortalarandSubtalarjointisacomplexbutbiomechanicallyimportantposteriorcalcanealfacet．Theyareseparatedby